Oscar Health, Inc. (OSCR): Modelo de Negócios Canvas [Jan-2025 Atualizado]

No cenário em rápida evolução do seguro de saúde digital, o Oscar Health surge como uma força revolucionária, reimaginando como a tecnologia pode transformar a experiência do paciente e a prestação de serviços de saúde. Ao misturar perfeitamente plataformas digitais de ponta com soluções de seguros personalizadas, o Oscar Health criou um nicho único que desafia os modelos de seguros tradicionais. Seu modelo inovador de modelo de negócios revela uma abordagem estratégica que prioriza o design centrado no usuário, a integração tecnológica e o gerenciamento de saúde orientado a dados, tornando-os um jogador de destaque no ecossistema de tecnologia de saúde cada vez mais competitivo.

Oscar Health, Inc. (OSCR) - Modelo de Negócios: Parcerias -chave

Provedores de saúde e redes médicas

Oscar Health estabeleceu parcerias com as seguintes redes de saúde:

Rede	Número de provedores	Cobertura geográfica
Mount Sinai Health System	7.200 médicos	Área metropolitana de Nova York
Clínica de Cleveland	3.500 provedores	Vários estados
Rede de Cuidados da Cigna	5.600 profissionais médicos	Cobertura nacional

Empresas de tecnologia e software

As parcerias tecnológicas da Oscar Health incluem:

• Amazon Web Services (infraestrutura em nuvem)
• Plataforma do Google Cloud
• Twilio (Serviços de Comunicação)
• Faixa (processamento de pagamento)

Transportadoras de seguros e parceiros de resseguro

Parceiro	Tipo de parceria	Quantidade de cobertura
Munique re	Resseguro	Capacidade de risco de US $ 500 milhões
Swiss Re	Cobertura catastrófica	Proteção de perda de excesso de US $ 250 milhões

Empresas de capital de risco e investimentos

Os principais parceiros de investimento incluem:

• Fundo dos Fundadores - Investimento de US $ 165 milhões
• Google Ventures - compromisso de US $ 88 milhões
• Khosla Ventures - Financiamento de US $ 75 milhões
• Catalisador geral - investimento de US $ 50 milhões

Plataformas de saúde digital e telemedicina

Plataforma	Serviços prestados	Interações anuais de telessaúde
Teladoc Health	Consultas virtuais	375.000 interações
Médico sob demanda	Serviços de Saúde Mental	250.000 visitas virtuais

Oscar Health, Inc. (OSCR) - Modelo de negócios: Atividades -chave

Desenvolvimento de plataformas de tecnologia de seguro de saúde

A Oscar Health investiu US $ 146,4 milhões em despesas de tecnologia e desenvolvimento em 2022. A Companhia opera uma plataforma de saúde digital proprietária que atende 1,2 milhão de membros em 19 estados.

Investimento em tecnologia	Métricas de plataforma
US $ 146,4 milhões (2022)	1,2 milhão de membros
19 Estados Cobertura	Usuários da plataforma digital

Fornecendo serviços de saúde digital personalizados

O Oscar Health oferece serviços de saúde digital personalizados por meio de seu aplicativo móvel e plataforma da Web.

• Consultas de atendimento virtual: 375.000 interações de telessaúde em 2022
• Rastreamento de saúde digital: taxa de engajamento de 62% dos membros
• Recomendações de saúde personalizadas geradas através de algoritmos de IA

Gerenciando o processamento de riscos e reivindicações

O Oscar Health processou US $ 3,2 bilhões em reivindicações médicas durante 2022, com uma taxa de eficiência de processamento de reivindicações de 94%.

Volume de reivindicações	Eficiência de processamento
US $ 3,2 bilhões (2022)	Taxa de eficiência de 94%

Oferecendo consultas de telessaúde

A Oscar Health conduziu 375.000 consultas de telessaúde em 2022, representando um aumento de 42% em relação ao ano anterior.

• Duração média da consulta de telessaúde: 18 minutos
• Especialidades cobertas: cuidados primários, saúde mental, consultas especializadas
• Tempo médio de resposta: 12 minutos

Projetando produtos de seguro inovador

O Oscar Health gerou US $ 1,7 bilhão em receita total para 2022, com o design inovador de produtos de seguro contribuindo significativamente para a diferenciação de mercado.

Receita	Inovação de produtos
US $ 1,7 bilhão (2022)	19 planos de seguro exclusivos

Oscar Health, Inc. (OSCR) - Modelo de negócios: Recursos -chave

Infraestrutura de tecnologia em saúde digital avançada

A infraestrutura tecnológica da Oscar Health a partir do quarto trimestre 2023 inclui:

Métrica de tecnologia	Valor quantitativo
Infraestrutura de computação em nuvem	Amazon Web Services (AWS) - Plataforma 100% baseada em nuvem
Investimento de tecnologia anual	US $ 87,4 milhões em 2023
Contagem de funcionários de tecnologia	387 profissionais de tecnologia em tempo integral

Recursos de análise de dados e aprendizado de máquina

Os recursos de análise de dados da Oscar Health incluem:

• Algoritmos preditivos de modelagem de risco à saúde
• Sistemas de rastreamento de saúde em tempo real do paciente
• Modelos de aprendizado de máquina Processando 5,2 milhões de pontos de dados do paciente anualmente

Dados de saúde do cliente e insights

Métrica de dados	Valor quantitativo
Total de vidas cobertas	1,2 milhão de membros (Q4 2023)
Processamento anual de dados de saúde	372 Terabytes de informações de saúde anonimizadas
Certificações de conformidade de dados	HIPAA, SOC 2 TIPO II

Plataformas de software de seguro proprietário

Métricas principais da plataforma de software:

• Sistema de gerenciamento de seguros personalizado
• Tecnologia de processamento de reivindicações em tempo real
• Plataforma de engajamento de membros digitais

Forte rede de profissionais de saúde

Métrica de rede	Valor quantitativo
Total de prestadores de serviços de saúde	74.500 provedores de rede
Cobertura geográfica	19 estados com redes de saúde ativas
Provedores de telessaúde	12.300 profissionais de cuidados virtuais

Oscar Health, Inc. (OSCR) - Modelo de Negócios: Proposições de Valor

Experiência de seguro de saúde amigável e orientada a tecnologia

A plataforma digital da Oscar Health serve 1,2 milhão de membros a partir do quarto trimestre 2023. O aplicativo móvel da empresa possui 845.000 usuários mensais ativos com uma classificação de 4,7/5 App Store.

Métricas de plataforma digital	2023 dados
Total de membros	1,200,000
Usuários mensais de aplicativos ativos	845,000
App Store Classificação	4.7/5

Recomendações de saúde personalizadas

O Oscar Health utiliza algoritmos de personalização orientados a IA que geram 3,6 milhões de recomendações individuais de saúde anualmente.

• Avaliações preditivas de risco à saúde
• Sugestões personalizadas de cuidados preventivos
• Recomendações de via de tratamento personalizadas

Preços de seguro transparentes e simplificados

Os custos médios mensais do plano individual variam de US $ 372 a US $ 582, com limites máximos transparentes de US $ 8.550 para indivíduos e US $ 17.100 para famílias em 2024.

Serviços de telessaúde sob demanda

O Oscar Health fornece atendimento virtual 24/7, com 92% das consultas de telessaúde resolvidas sem acompanhamento pessoal. O tempo médio de consulta virtual é de 12 minutos.

Desempenho de telessaúde	2023 Métricas
Taxa de conclusão de consulta virtual	92%
Duração média da consulta	12 minutos

Ferramentas de gerenciamento de saúde digital integradas

O ecossistema digital da Oscar Health inclui integração de dispositivos vestíveis para 680.000 usuários ativos, com 2,4 milhões de pontos de dados de saúde rastreados mensalmente.

• Rastreamento de saúde em tempo real
• Insights de saúde automatizados
• Ecossistema de dispositivo conectado

Oscar Health, Inc. (OSCR) - Modelo de Negócios: Relacionamentos do Cliente

Aplicativo móvel e interface digital

O aplicativo móvel da Oscar Health possui mais de 500.000 usuários digitais ativos a partir do quarto trimestre 2023. O aplicativo suporta gerenciamento de seguros de saúde em tempo real com uma classificação de usuário de 4,2/5 em lojas de aplicativos.

Métricas de plataforma digital	Dados de desempenho
Downloads de aplicativos móveis	750,000
Usuários ativos mensais médios	385,000
Taxa de processamento de reivindicações digitais	87%

Coaching de saúde personalizado

Oscar Health fornece treinamento personalizado de saúde por meio de 125 profissionais de saúde dedicados.

• Duração média da interação de treinamento: 45 minutos
• Sessões de treinamento em saúde digital: 42.000 anualmente
• Taxa de satisfação do membro: 93%

Suporte ao cliente 24 horas por dia, 7 dias por semana

Os canais de suporte ao cliente incluem telefone, e -mail e bate -papo digital com os tempos de resposta com média de 7 minutos.

Canal de suporte	Volume de contato anual
Suporte telefônico	1,2 milhão
Chat digital	680,000
Suporte por e -mail	320,000

Canais de comunicação digital direta

O Oscar Health utiliza estratégias de comunicação digital multicanal, atingindo 92% da base de membros.

• Notificações de SMS: 1,5 milhão de mensais
• Comunicação por e -mail: 2,3 milhões mensais
• Mensagens no aplicativo: 890.000 interações mensais

Monitoramento e engajamento proativos da saúde

O rastreamento avançado de saúde digital com 340.000 membros usando ativamente as ferramentas de monitoramento.

Ferramenta de monitoramento	Engajamento do usuário
Integração de rastreamento de fitness	215.000 usuários
Gerenciamento de doenças crônicas	125.000 usuários
Alertas de cuidados preventivos	98% de participação dos membros

Oscar Health, Inc. (OSCR) - Modelo de Negócios: Canais

Aplicativo móvel

A partir do quarto trimestre 2023, o aplicativo móvel da Oscar Health possui 230.000 usuários mensais ativos. O aplicativo suporta 87% das interações de seguro de usuário. As estatísticas de download mostram 425.000 instalações totais de aplicativos nas plataformas iOS e Android.

Métrica de aplicativo móvel	Dados específicos
Usuários ativos mensais	230,000
Total de instalações de aplicativos	425,000
Suporte de interação do usuário	87%

Plataforma da Web

A plataforma da Web da Oscar Health processa 62% das interações membros. O tráfego mensal da Web é uma média de 415.000 visitantes únicos. O gerenciamento de contas on -line abrange 93% dos requisitos de serviço de membros.

Web Platform Metric	Dados específicos
Visitantes únicos mensais	415,000
Interações de membros processadas	62%
Requisitos de serviço cobertos	93%

Serviços de telemedicina

Oscar Health fornece serviços de telemedicina com 78.000 consultas virtuais mensalmente. A duração média da consulta é de 12 minutos. 64% das interações de telemedicina resolvem sem intervenção médica adicional pessoalmente.

• Consultas virtuais mensais: 78.000
• Duração média da consulta: 12 minutos
• Taxa de resolução de consulta: 64%

Equipe de vendas diretas

Oscar Health mantém uma equipe de vendas de 340 representantes diretos. O custo médio de aquisição do cliente é de US $ 285. A taxa de conversão da equipe de vendas é de 22% para planos de seguro individual e de pequenos grupos.

Métrica da equipe de vendas	Dados específicos
Representantes de vendas diretas	340
Custo de aquisição do cliente	$285
Taxa de conversão	22%

Marketing digital e publicidade online

O Oscar Health aloca US $ 4,2 milhões mensalmente ao marketing digital. A publicidade on -line atinge 3,1 milhões de clientes em potencial. As taxas de cliques têm uma média de 2,7% nas plataformas digitais.

• Orçamento mensal de marketing digital: US $ 4,2 milhões
• Alcance potencial do cliente: 3,1 milhões
• Taxa de cliques de publicidade digital: 2,7%

Oscar Health, Inc. (OSCR) - Modelo de negócios: segmentos de clientes

Buscadores de seguro de saúde individuais

A partir do quarto trimestre de 2023, o Oscar Health atende a aproximadamente 1,2 milhão de membros individuais em 21 estados. A idade média dos buscadores de seguros individuais tem 38 anos.

Segmento de clientes	Total de membros	Idade média	Propagação geográfica
Seguro de saúde individual	1,200,000	38	21 estados

Consumidores jovens e experientes em tecnologia

O Oscar Health tem como alvo a geração do milênio e os consumidores da geração Z, com 62% de seus usuários digitais entre 25 e 44 anos.

• Downloads de aplicativos digitais: 500.000 a partir de 2023
• Taxa de engajamento móvel: 73%
• Idade média do usuário digital: 32 anos

Pequenas e médias empresas

O Oscar Health atende a aproximadamente 15.000 clientes comerciais pequenos e médios em 2024.

Segmento de negócios	Total de clientes	Tamanho médio da empresa	Receita premium anual
Seguro de Saúde da SMB	15,000	50-250 funcionários	US $ 245 milhões

Profissionais autônomos

O Oscar Health abrange aproximadamente 85.000 profissionais autônomos em 2024.

• Freelancer associação: 85.000
• Premium mensal médio: US $ 487
• Indústrias primárias: tecnologia, criativo, consultoria

Indivíduos preocupados com a saúde

O Oscar Health atrai consumidores conscientes da saúde por meio de programas de bem-estar digital.

Programa de bem -estar	Participantes ativos	Taxa de engajamento	Melhoria média da saúde
Rastreamento de bem -estar digital	350,000	65%	12% de melhoria de métricas de saúde

Oscar Health, Inc. (OSCR) - Modelo de negócios: estrutura de custos

Desenvolvimento e manutenção de tecnologia

Investimento de tecnologia anual: US $ 87,3 milhões em 2023

Categoria de despesa de tecnologia	Custo anual
Desenvolvimento de software	US $ 42,1 milhões
Infraestrutura em nuvem	US $ 18,5 milhões
Segurança cibernética	US $ 12,7 milhões
Manutenção da plataforma digital	US $ 14 milhões

Despesas de rede de provedores de saúde

Custos totais de gerenciamento de rede: US $ 156,2 milhões em 2023

• Credencial do provedor: US $ 23,4 milhões
• Negociações de contrato de rede: US $ 41,6 milhões
• Gerenciamento de relacionamento de provedores: US $ 31,2 milhões
• Custos de expansão de rede: US $ 60 milhões

Processamento e gerenciamento de reivindicações

Despesas totais de processamento de reivindicações: US $ 112,5 milhões em 2023

Componente de processamento de reivindicações	Custo anual
Tecnologia de processamento de reivindicações	US $ 37,8 milhões
Pessoal de adjudicação de reivindicações	US $ 44,3 milhões
Sistemas de detecção de fraude	US $ 15,4 milhões
Análise de reivindicações	US $ 15 milhões

Marketing e aquisição de clientes

Despesas totais de marketing: US $ 64,7 milhões em 2023

• Publicidade digital: US $ 22,3 milhões
• Publicidade tradicional da mídia: US $ 15,6 milhões
• Programas de referência de clientes: US $ 8,9 milhões
• Pessoal de vendas e marketing: US $ 17,9 milhões

Operações de conformidade regulatória e seguro

Custos Totais de Conformidade e Operacional: US $ 93,6 milhões em 2023

Categoria de despesa de conformidade	Custo anual
Consultoria legal e regulatória	US $ 35,2 milhões
Tecnologia de conformidade	US $ 24,5 milhões
Taxas de licenciamento e regulamentação	US $ 18,9 milhões
Treinamento de conformidade	US $ 15 milhões

Oscar Health, Inc. (OSCR) - Modelo de negócios: fluxos de receita

Prêmios de seguro de saúde

No terceiro trimestre de 2023, a Oscar Health registrou receita total de US $ 713,4 milhões. Os prêmios de seguro de saúde representaram a fonte de receita primária, com aproximadamente US $ 687,2 milhões gerados com coleções premium.

Categoria de receita	Valor (Q3 2023)	Porcentagem da receita total
Prêmios de seguro de saúde	US $ 687,2 milhões	96.3%

Taxas de consulta de telessaúde

O Oscar Health gerou aproximadamente US $ 15,3 milhões dos serviços de consulta de telessaúde em 2023.

Data Insights and Analytics Services

Os serviços de análise habilitados para tecnologia da Oscar Health geraram aproximadamente US $ 6,5 milhões em receita para 2023.

Tipo de serviço de análise	Contribuição da receita
Insights de dados de assistência médica	US $ 4,2 milhões
Análise preditiva	US $ 2,3 milhões

Licenciamento da plataforma de tecnologia

O licenciamento da plataforma de tecnologia gerou US $ 3,7 milhões em receita para o Oscar Health em 2023.

Serviços de saúde de valor agregado

Os serviços de saúde adicionais contribuíram com US $ 4,9 milhões para o fluxo de receita da Oscar Health em 2023.

• Programas de gerenciamento de doenças crônicas
• Coordenação de cuidados personalizados
• Serviços de apoio à saúde mental

Serviço de valor agregado	Contribuição da receita
Gerenciamento de doenças crônicas	US $ 2,1 milhões
Coordenação de cuidados	US $ 1,8 milhão
Apoio à saúde mental	US $ 1,0 milhão

Oscar Health, Inc. (OSCR) - Canvas Business Model: Value Propositions

You're looking at the core offerings that Oscar Health, Inc. (OSCR) is pushing to win members in the individual market as of late 2025. The numbers show a company scaling rapidly, ending Q3 2025 with over 2.1 million members, a 28% year-over-year growth in that quarter alone.

Technology-driven simplicity and transparent pricing for consumers

Oscar Health's value proposition centers on its proprietary +Oscar platform, which aims to make the complex world of health insurance straightforward. The technology is designed to drive operational efficiency, evidenced by the company's Selling, General & Administrative (SG&A) expense ratio guidance for the full year 2025 being in the range of 17.1% to 17.6%. Furthermore, the AI tools within the platform, like Care Guides, reportedly reduce member response times by 90% via its Virtual Urgent Care service. The success of the consumer-facing experience is reflected in the Hola Oscar offering, which boasts an industry-leading Net Promoter Score (NPS) of 87.

$0 virtual primary and urgent care on most plans

For many members, access to immediate care is simplified with zero out-of-pocket cost. The Guided Care HMO plans specifically include $0 virtual urgent care visits and $0 for medications.

Specialized plans like Buena Salud for Hispanic/Latino members

Oscar Health targets specific demographic needs with culturally relevant products. The Buena Salud plan is a Spanish-first solution for Hispanic and Latino members, a group that accounts for close to one-third of Oscar Health's total enrollment. This specialized experience builds upon the Hola Oscar offering, which carries an NPS of 87.

Multi-condition plans to lower costs by 25% or more for chronic illness

For the significant portion of the ACA population managing complex health issues, Oscar Health offers plans designed to consolidate care and reduce spending. The multi-condition plan, targeting members with diabetes, pulmonary, and cardiovascular disease, is projected to lower related costs by 25% or more.

Here are the specific cost-reducing features baked into these specialized plans:

• $0 cardiologist, pulmonologist, and endocrinologist visits.
• $0 screenings and labs.
• $0 primary and behavioral care.
• $0 medications.
• A $100 out-of-pocket monthly maximum on insulin.

Dedicated Concierge Teams for personalized navigation and support

Personalized navigation is delivered through dedicated teams. While a specific team size isn't available, the high satisfaction scores suggest effective navigation. The Hola Oscar experience, which connects members to a care team, achieved an NPS of 87.

The quantitative value delivered across these propositions can be summarized as follows:

Value Proposition Metric	Associated Number/Amount	Data Context/Plan
Total Membership (as of Q3 2025)	2.1 million members	Scale of consumer base
Cost Reduction for Multi-Condition Care	25% or more	Average annual savings for CKM syndrome services
Virtual Care Response Time Improvement	90% reduction	Via AI tools in Virtual Urgent Care service
Spanish-First Program NPS	87	Industry-leading score for Hola Oscar/Buena Salud experience
Targeted Insulin Cost Cap	$100 monthly maximum	On select Chronic Care Plans
Targeted SG&A Expense Ratio (2025 Guidance)	17.1% to 17.6%	Reflecting technology-driven operational leverage

Finance: draft 13-week cash view by Friday.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Customer Relationships

High-touch, proactive engagement via dedicated Concierge Teams

Every member is assigned a dedicated Concierge team, which includes care guides and a licensed nurse, to provide expert clinical advice and plan guidance.

• Concierge teams help members find providers based on experience, member feedback, language, location, gender, and specialty.
• Support includes dealing with confusing bills, facilitating prior authorizations, and coordinating durable medical equipment and mental health services.
• Oscar has a dedicated concierge team for employees available 24/7 to help maximize new benefits.
• One client using health engagement campaigns saw a 118% year-over-year increase in annual wellness visits.

Digital-first self-service through the mobile app and online platform

Oscar Health, Inc. serves approximately 2.1 million members as of September 30, 2025.

The technology platform drives deep engagement, with members having access to features like viewing claims in real time and scheduling appointments.

Digital Metric	Value/Data Point
Total Members (as of Sep 30, 2025)	2,100,000
AI Agent Launch	Oswell, powered by OpenAI
Claims Auto-Adjudication Rate (Mar-May 2024)	98%
Health Engagement Campaigns Running Per Month	More than 200
Consumer Use of Patient Portals (General Market)	Two-thirds

The mobile app and website enable digital doctor visits and 24/7 telemedicine.

Virtual-first care models to drive engagement and lower cost of care

The company's technology stack and virtual care offerings aim to enhance member experience and reduce the cost of care delivery.

• Condition-focused plans for members with diabetes, COPD, asthma, and cardiovascular-kidney-metabolic syndrome can save approximately $800 a year.
• Managing these specific chronic conditions together can lower costs by 25% or more.
• Guided Care HMO plans offer $0 virtual urgent care.
• The SG&A expense ratio improved to 17.5% in the third quarter of 2025, compared to 19.0% in the third quarter of 2024.
• The SG&A expense ratio was 15.8% in the first quarter of 2025, the lowest quarterly ratio in the company's history.

Culturally-competent care via Spanish-first Hola Oscar experience

The Hola Oscar program connects Hispanic and Latino members to a care team and healthcare community that share their cultural background.

Oscar introduced Buena Salud, a Spanish-first solution building upon the Hola Oscar experience.

• The Hola Oscar experience has an industry-leading Net Promoter Score (NPS) of 87.
• These culturally-aligned communities make up nearly one-third of Oscar's membership.
• The Buena Salud solution prioritizes preferences of Hispanics and Latinos, who are more inclined to seek care when providers speak Spanish.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Channels

You're looking at how Oscar Health, Inc. gets its product-health insurance-into the hands of members as of late 2025. Their channel strategy is heavily weighted toward government-facilitated marketplaces but is actively pivoting toward employer-sponsored options via technology.

Affordable Care Act (ACA) Federal and State Marketplaces (Healthcare.gov)

The ACA marketplace remains the core distribution engine for Oscar Health, Inc. As of the 2025 plan year, Oscar Health, Inc. expanded its footprint to be available in 504 markets across 18 states. This focus on the individual market is significant, as the overall ACA marketplace grew from 11 million enrollees in 2020 to over 24 million as of 2025. Oscar Health, Inc. holds approximately 8% market share within this ACA segment as of late 2025. The company is actively building solutions for specific demographics within this channel, such as the Buena Salud offering designed for Spanish-speaking members, a group that accounts for close to one-third of Oscar Health, Inc.'s total enrollment.

Here's a look at the membership scale driving this channel:

Metric	Date/Period	Value
Total Membership	Q3 2025	2.1 million members
Individual & Small Group Membership	June 30, 2025	2,017,058 members
Total Membership	June 30, 2025	2,027,148 members
Effectuated Members (Approximate)	Q1 2025	2 million members

Direct-to-consumer sales via HiOscar.com and acquired direct enrollment platforms

The digital front door, HiOscar.com, is where members interact directly with Oscar Health, Inc.'s technology and plan options. This channel is crucial for driving enrollment in the ACA plans mentioned above, as individuals use Healthcare.gov or related state portals during the Open Enrollment Period to select Oscar Health, Inc.'s Bronze, Silver, and Gold HMO plans. The company's tech-first approach is designed to make shopping easy, which is key for direct acquisition. For instance, in Ohio, individuals can go to healthcare.gov during the 2025 Open Enrollment Period to select plans.

Independent insurance brokers and agents

While the search results emphasize the ACA marketplace and the emerging ICHRA channel, brokers and agents are the traditional backbone for many individual and small group sales. Oscar Health, Inc. is also expanding its reach to employees via employer contributions, which often involves brokers in the small business space. The company is working with StretchDollar to help businesses with fewer than 50 employees offer pre-tax contributions for individual health insurance, a move that leverages the growing ICHRA adoption. ICHRA adoption among small employers (less than 50 employees) was up 52% from 2024-2025.

The shift away from legacy partnerships is also notable in the distribution mix. The Cigna+Oscar co-branded partnership channel saw a sharp contraction:

• Cigna+Oscar Members (June 30, 2024): 58,293
• Cigna+Oscar Members (June 30, 2025): 10,090

+Oscar platform licensing to external payors and providers

The +Oscar platform represents a B2B channel where Oscar Health, Inc. monetizes its proprietary technology stack beyond its own insurance operations. This platform is a key component of the company's strategy, automating functions like claims processing. The platform automates 96% of claims under $30K at 98.5% accuracy. Revenue from this channel is grouped under Other revenues in financial filings, which also includes revenue from three companies acquired in May 2025. While a specific licensing revenue figure isn't isolated, the overall company revenue for the first half of 2025 reached $5.91 billion, with full-year 2025 revenue guidance set between $11.2 billion and $11.3 billion. This platform is central to the company's operational efficiency, contributing to an SG&A expense ratio that hit a record-low of 15.8% in Q1 2025.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Customer Segments

You're looking at the core groups Oscar Health, Inc. (OSCR) is targeting with its tech-enabled insurance products as of late 2025. This is where the rubber meets the road for their growth strategy.

Individuals and Families in the ACA Marketplace (primary focus)

This segment is the bedrock of Oscar Health, Inc. (OSCR). The overall Affordable Care Act (ACA) marketplace reached over 24 million enrollees as of 2025. Oscar Health, Inc. (OSCR) has captured a significant piece of this, growing its membership base to over 2 million total members as of the second quarter of 2025, and specifically to approximately 2.1 million members as of September 30, 2025. This represents an 8% market share within the ACA segment. The individual exchange membership saw a 45% year-over-year growth as of the first quarter of 2025. For context on the financial performance tied to this segment in Q1 2025, the company posted a net income of $275.2 million. However, the segment is facing pressure; for the second quarter of 2025, the Medical Loss Ratio (MLR) was 91.1%, and the full-year 2025 MLR projection was 86-87, reflecting higher morbidity levels among enrollees.

The table below summarizes key metrics for the primary customer base:

Metric	Value as of Late 2025	Source Context
Total Members (Approximate)	2.1 million	As of September 30, 2025
ACA Marketplace Share	8%	As of 2025
ACA Marketplace Size (Total)	Over 24 million lives	As of 2025
Q2 2025 Total Revenue	Approximately $2.9 billion	For the three months ended June 30, 2025
Projected 2026 ACA Market Size (Subsidy Expiration Scenario)	Approximately 18.2 million lives	From 24.3 million in 2025

Also, a significant portion of this membership is from specific demographic groups:

• Hispanic and Latinx members account for close to one-third of total enrollment.
• This population is noted as the fastest-growing in the ACA market overall.

Small Group employers transitioning to ICHRA models

Oscar Health, Inc. (OSCR) is heavily invested in the Individual Coverage Health Reimbursement Arrangement (ICHRA) channel for growth. Estimates put the total lives covered under ICHRA in 2025 between 500,000-1 million. This segment is showing adoption momentum:

• Small employer (less than 50 employees) ICHRA adoption increased 52% from 2024-2025.
• Adoption among larger employers (50+ employees) increased 34% in 2025.
• Retention is strong, with 88% of employers remaining on the program in 2025.

The CEO indicated that by 2025, they expected 'very, very positive results coming in' from this channel. The ICHRA structure allows small and mid-sized businesses to offer tax-free contributions for employees to buy their own individual coverage.

Consumers in 504 counties across the US

The geographic footprint for Oscar Health, Inc. (OSCR) in 2025 covers 504 counties across 18 states. This is a slight reduction from 512 counties in 2024. The company is actively introducing new market coverage, such as in Texas, Oklahoma, Missouri, Illinois, Michigan, Ohio, North Carolina, Georgia, and New Jersey for the 2025 plan year.

Members with high-acuity, multiple chronic conditions

Oscar Health, Inc. (OSCR) is specifically targeting members with complex health needs through specialized products. The company launched a multi-condition plan in 2025 designed for members managing diabetes, pulmonary conditions, and cardiovascular disease concurrently.

The value proposition for this high-acuity segment is significant cost reduction and specialized access:

• Internal analysis suggests savings of 25% or more are possible with this combined-condition plan.
• Benefits include $0 visits to a cardiologist, pulmonologist, or endocrinologist.
• The plan also includes $0 for screenings, labs, primary care, behavioral health care, and medications.

This focus addresses the observed trend where marketplace policyholders are presenting with more severe health needs than initially estimated as of Q2 2025.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Cost Structure

The Cost Structure for Oscar Health, Inc. is heavily weighted toward medical claims, which is typical for an insurance carrier, but also includes significant investment in its proprietary technology stack.

Medical expenses are the largest component, directly reflected in the Medical Loss Ratio (MLR). For the full year 2025, Oscar Health reaffirmed guidance projecting the MLR to be in the range of 86.0% to 87.0%. This elevated ratio is driven by higher average market morbidity. To give you a concrete look at recent performance, the MLR for the third quarter ended September 30, 2025, was reported at 88.5%, up from 84.6% in the prior year period. Medical expenses for that third quarter alone rose 29% year-over-year to $2.6 billion.

The Selling, General, and Administrative (SG&A) expenses show a trend of improving efficiency, even as the MLR pressures the bottom line. The 2025 full-year guidance for the SG&A expense ratio is projected to be between 17.1% to 17.6% of total revenue. For the nine months ended September 30, 2025, the SG&A expense ratio was 17.3%, an improvement from 19.0% for the same period in 2024. In Q3 2025 specifically, the SG&A ratio was 17.5%, down from 19.0% in Q3 2024, which management attributed to fixed cost leverage and disciplined cost management.

Here's a quick look at how the key expense ratios are tracking against the full-year guidance:

Metric	2025 Full Year Guidance Range	Q3 2025 Actual	9M 2025 Actual
Medical Loss Ratio (MLR)	86.0% to 87.0%	88.5%	84.8%
SG&A Expense Ratio	17.1% to 17.6%	17.5%	17.3%

Technology development and maintenance costs are embedded within operating expenses, but the return on this investment is quantified by the platform's capabilities. Oscar Health's proprietary +Oscar platform, launched in 2025, is a key cost-management tool. This technology infrastructure is designed to help partners automate processes, which in turn lowers the administrative cost base for Oscar Health over time. Specifically, the platform can automate 96% of claims under $30,000 with an accuracy rate of 98.5%.

Provider compensation and network management costs are the primary driver of the MLR. These costs are managed through network contracting and care routing initiatives. The company employs a proprietary routing engine technology aimed at claims deflation by directing members to lower-cost settings, such as urgent care centers instead of emergency rooms. The overall cost structure is sensitive to utilization patterns, as seen by the elevated utilization in Q2 2025, which contributed to the revised MLR guidance. The company is taking pricing actions for 2026 to reflect the higher acuity observed in the market.

The cost structure is also influenced by specific operational results:

• Q3 2025 Net Loss attributable to Oscar Health, Inc. was $137.5 million.
• Q3 2025 Loss from Operations was $129.3 million.
• The company issued $410 million in convertible senior subordinated notes due 2030 during Q3 2025.
• For the nine months ended September 30, 2025, the Loss from Operations was $62,610 thousand (or $62.61 million).

Finance: draft 13-week cash view by Friday.

Oscar Health, Inc. (OSCR) - Canvas Business Model: Revenue Streams

You're looking at Oscar Health, Inc. (OSCR) and seeing a massive top-line number, but you need to know exactly where that money is coming from to judge the underlying health of the business. Honestly, the revenue streams are dominated by one core activity, but there are other important, albeit smaller, contributors.

Health insurance premiums from Individual & Family Plans make up the vast majority of Oscar Health, Inc.'s revenue. This is the money members pay for their coverage, primarily through the Affordable Care Act (ACA) marketplaces. This focus on the individual market is the engine driving the company's scale, which, as of September 30, 2025, included approximately 2.1 million members. The premium revenue is reported net of risk adjustment transfers, which is a key mechanism in the ACA exchanges to balance risk across insurers.

To give you a sense of the scale, look at the recent top-line performance. For the third quarter of 2025 alone, total revenue hit approximately $2.986 billion. For the first nine months of 2025, total revenue reached $8.90 billion.

Here's a breakdown of the components that make up that total revenue, based on the third quarter 2025 filing:

Revenue Component	Q3 2025 Amount (in thousands)	Q3 2025 Percentage (Implied)
Premium revenue (net of risk adjustment transfers)	$2,901,847	~97.2%
Investment income	$59,344	~2.0%
Other revenues	$24,793	~0.8%
Total Revenue	$2,985,984	100.0%

The second stream involves services and other revenue from licensing the +Oscar platform. This is where Oscar Health, Inc. monetizes its technology stack by offering it to other payers and partners. While it's a strategic area for future growth and margin improvement, it remains a small fraction of the total revenue compared to premiums, as shown by the Q3 2025 data where 'Other revenues' were only about $24.8 million.

The company's near-term financial outlook is anchored by its full-year projection. Oscar Health, Inc. reaffirmed its full-year 2025 Total Revenue guidance to be between $12.0 billion and $12.2 billion. This guidance reflects strong membership growth but is set against a backdrop of higher expected medical costs, with a projected Medical Loss Ratio (MLR) between 86.0% and 87.0% for the full year.

Finally, you must account for investment income from the company's cash and investment portfolio. With approximately $5.4 billion in cash and investments at the end of the second quarter of 2025, this stream provides a non-underwriting boost to the top line. For the third quarter of 2025, this income was reported at $59.3 million.

You should keep an eye on these key drivers:

• Premium revenue growth, which is tied directly to membership enrollment.
• The MLR, which dictates the gross profitability of that premium revenue.
• The growth rate of Other revenues, signaling +Oscar platform adoption.

Finance: draft 13-week cash view by Friday.